| NPI | 1386698538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: TX L0814) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 24870) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2012-05-23 |